Enrollment Agreement

Enrollment Agreement

Thank you for your interest in enrolling with Finance Your Care. Please complete the information below so we can get your Practice set up, and we can identify the lenders in our portfolio that will be the best fit for your Practice. If you have any questions, please call (844) 995-4657.
What is the legal name of your Practice*
Make sure you include (LLC, PA, Inc)
What is your EIN (tax id) number?*
What is your Practice specialty (i.e. Chiropractic, Plastic Surgery, etc.)*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice Phone Number*
What is the Practice email*
Who is the contact person we should call or email?*

First NameLast Name
Contact person's phone number if different than above
Please enter a valid phone number.
Contact person's email if different than above
example@example.com
What is your Practice website?*
What is the Doctor's or Owner's name*

First NameLast Name
How many loans do you close every month?*
What is your average loan amount?*
Please list the patient financing companies you are currently using.
Enrollment Options
Fully Automated: This is the format that most Practices use. With this enrollment option, you (or the Applicant) will process the application through our automated system from start to close. The process takes about five minutes.

Finance Manager Assisted: This enrollment format was designed for Providers that really do not want to be involved in the loan process. With this format, you (or the Applicant) will submit the application and get a pre-qualification only. At that point, one of our Finance Managers will take over the processing and get the request submitted to the lenders. The benefit to this format is it will free up your staff's time and often leads to more approvals. The negative is that the turn-around time for a final decision may be up to one business day.
Which type of enrollment plan do you prefer?*
Please review the following lender program options, and let us know which of these programs you would like to enroll to use. NOTE: These are third party lender programs.
PRIME CREDIT: Lender programs for people with credit scores above 680. Loan amounts up to $35,000. Terms up to 60 months. APR's between 6.9% and 19.9%. Most offers include 12 months same as cash. The typical fee to your Practice is 7%. Do you want to offer these programs?*

YesNoI would need to learn more.
GOOD CREDIT: Lender programs for people with credit scores between 640 to 679. Loan amounts up to $25,000. Terms up to 60 months. APR's between 12.9% and 21.9%. Most offers include 12 months same as cash. The typical fee to your Practice is 10%. Do you want to offer these programs?*

YesNoI would need to learn more.
FAIR CREDIT: Lender programs for people with credit scores between 600 and 639. Loan amounts up to $15,000. Terms up to 48 months. APR's between 12.9% and 24.9%. The typical fee to your Practice is 15%. Do you want to offer these programs?*

YesNoI would need to learn more.
POOR CREDIT: Lender programs for people with credit scores between 550 and 599. Loan amounts up to $15,000. Terms up to 48 months. APR's between 16.9% and 29.9%. The typical fee to your Practice is 22%. Do you want to offer these programs?*

YesNoI would need to learn more.
BAD / NO CREDIT: Lender programs for people with credit scores of 549 or below. Loan amounts up to $6,000. Terms up to 24 months. APR's between 18.9% and 35.9%. The typical fee to your Practice is 25%. Do you want to offer these programs?*

YesNoI would need to learn more.
Fee Disclosure:

Credit Technologies has no interest in charging your practice a direct fee to use our technology. On the other hand, we cannot allow a practice to have the platform and then never close a loan while using it. Therefore, we have the following fee structure. We will charge each of your customers a minimum User's Fee of $187.50. As long as you close a minimum of two loans per month or generate a minimum monthly fee collection of $375, we will not charge you a fee. But if you have a month in which you do not close at least two loans or generate a minimum of $375 in fees to Credit Technologies, we will send you an invoice for the shortfall for that month. As to how we collect the fee from your customer... We can program your financing platform to require the Applicant to enter a credit or debit card payment method, or to have the fee added to the loan amount. If we collect the payment method upfront, it will only be charged after we verify the application was approved. If you allow them to add the fee to the loan amount, you will be responsible for paying our invoice after you have been funded which would have included our fee paid to your practice.
Do you understand the fee structure as outlined?*

YesNo, cancel my enrollment
Do you want us to collect a payment method from your customer at time of pre-approval, or do you want us to bill and collect this fee from your business using a stored payment method?*

Yes, collect the fee directly from the Applicant.No, invoice my business for each funding fee.
One Time Set Up Deposit:

As a part of your enrollment, we charge a one-time set up deposit fee of $375. This fee must be paid at the time you enroll. However, this fee will be credited back to you after six months using the platform. Again, this fee is charged to prevent a business from signing up "just because it is free". PLEASE NOTE: We will send you an invoice for this deposit after we receive this form back.
Do you understand and agree to the one time set up fee of $375?*

YesNo, cancel my enrollment
Enrollment Term:

This agreement will be based on a month-to-month agreement that can be cancelled by either party with a 30 days notice. However, if you have an outstanding balance at time of cancellation, you will be required to pay that balance within 30 days.
What happens next:

Once we receive your enrollment request, we will contact your Practice and discuss the lender programs you are interested in enrolling to use. Then we will send you a check list of the documents each lender will require you to provide for their enrollment, and another form like this that you can use to upload those documents. As soon as we get those documents back, we will start your enrollments with the lenders. Most of the lenders will take between 7 and 10 business days to approve your practice and set you up. But don't worry, we will be here to support the process and push it along the way.
Thank you for submitting your enrollment request. If you have any questions or concerns, please call (844) 995-4657.
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Enrollment Agreement

Enrollment Options

Fee Disclosure:

One Time Set Up Deposit:

Enrollment Term:

What happens next: